Water Fluoridation: In Assam’s Tapatjuri, almost every home is affected by some form of fluorosis

One of the most visible effects of long exposure to high fluoride content has been on the physical appearance of the villagers

In an age when children normally discover the thrill of being able to walk by themselves and run around, two-year-old Amjad was handed a walking stick by his mother to aid his limp. His legs were bent — a typical sign of skeletal fluorosis — and as he struggled to hold his own, his heartbroken mother would keep a close watch.

Amjad’s is not an exceptional case in this village. Tragically, almost every home in Tapatjuri has children (and adults) affected by some form of fluorosis. The culprit? Drinking water.

Tapatjuri in Hojai district is one of the worst-affected when it comes to fluoride contamination of groundwater in Assam. The permissible limit of fluoride in water is 1 mg/l; in water samples sourced from hand-pumps or tube-wells from Tapatjuri, its levels were found to be as high as between 10-15 mg/l. The effects naturally have been devastating.

One of the most visible effects of long exposure to high fluoride content has been on the physical appearance of the villagers. One can hardly find a child, or an adult, without stained or crooked teeth — symptoms of dental fluorosis. And almost every inhabitant of the village suffers from pain in joints and body aches. So much so that children often miss school — a classic example of how this goes beyond the realm of a health issue.

Ten-year-old Rohima complained that her legs “pain all the time”. As she hid a shy smile with her hand, giving just a glimpse of her stained teeth, she said the pains are common in her home: Her four sisters and brother also suffer. “I have to miss school sometimes because I just can’t walk.” Hamjad, who is in Class 6, similarly said that he often carries a nagging pain in his knees and while he does “manage to attend school and play”, there are days when he gives up. “It’s because of the water we drink,” the young boy said, indicating the growing level of awareness among the villagers about the contaminated ground water.

Social activist Dharani Saikia, who has been working on the issue and in this village over the past many years, said that tube-wells or hand pumps that drill 100-150 feet below ground have been pumping up high levels of fluoride in the water and are the reason behind this “slow poisoning”. “When you drill that deep you reach the granitic rocks that are rich in minerals like fluoride, thereby pumping up excess of it in the water,” Saikia said, “This is why ring-wells, which require to be dug only 10-12 feet, are a safer option and we have been advocating the use of that.”

Ironically, villages near Tapatjuri are not as severely affected by cases of fluorosis; Saikia says it could be because of the topographical location of the village.

In the case of Amjad, his mother, Halima Begum, said that when she realised that her son — at that time just 18 months old — could not stand on his own unlike other children, she ran from pillar to post, from the local quack to doctors, for help. “There were x-rays, medicines, oil massages — nothing worked. His legs became bent and he had to walk with the help of a stick for five years,” she said. But even as he struggled, more challenges awaited him.

“Until I was in the primary school (Class 5) which was adjacent my house, my friends would help me walk to and fro. But the middle school was two kilometres away and I just couldn’t walk that far,” the young boy, now 12, said. He missed a school year.

Under medical guidance, Saikia, in the meanwhile, had started distributing tablets with a combination of calcium, vitamin D, magnesium and zinc among the affected population. Although guidelines under the National Programme for Prevention and Control of Fluorosis (NPPCF) under the Union Health Ministry states that dental and skeletal changes because of high fluoride exposure are irreversible, people in Tapatjuri have expressed relief as a result of this supplement. Children below the age of seven have even reported full recovery after being administered these supplements along with nutritional changes like more greens in their diet, Saikia said.

But for a tangible solution — and prevention of new cases — the root of the problem must be addressed, which, in this case, is alternate source of water. Experts like Najibuddin Ahmed, former Additional Chief Engineer of the Assam Public Health Engineering Department (PHED), say that the solution lies in treated surface water. In line with this thought, PHED has been supplying treated river water to villages like Tapatjuri through its different water supply schemes. One such water supply comes from the river Udhogonga; another from Dhikaramukh. Another on the way is from the Jamuna river — water from all these sources is treated and then supplied through taps which are common among few households.

“We have stopped drinking tube-well water; only tap water now. I think the problem is improving but the aches and pains are still common,” said 47-year-old Abdul Kalam, a daily wage earner. Two of his nephews have been crippled as a result of skeletal fluorosis. A study has shown that symptoms of fluorosis appeared in Tapatjuri in 1978, and between 1993-2003, the number of cases doubled. Between 2003-2008, the numbers increased four times, and between 2008-2013, six times.

In a positive bend, after 2013, when the surface water supply schemes began and awareness about the disease spread, the number of cases have witnessed a slight drop. As of now, 34 per cent of the village suffers from pronounced symptoms of high fluoride exposure.

“The problem is improving and will further improve when the Jamuna (river) water supply to Tapatjuri and four other villages in the vicinity commence,” said Ajit Nath of the PHED department, looking after the Dhikaramukh Water Supply Scheme.

But Deepshika Saikia, who was the Assistant Commissioner in Hojai until recently, feels that more needs to be done. “It is just slow poisoning,” she said, “There has to be persistent and collaborative efforts from all quarters to treat this problem that is not just a health issue, but also has economic and social implications.” Frequent transfers of government officials who oversee welfare schemes and administration, she feels, break the momentum of an improving graph.

Persistent support does go a long way — Amjad knows why. His legs are still bent, but he can now walk to school. “I love playing volleyball. There’s nothing I look forward to more than going to school on my own every day,” he said.